Publication details
Dětská spánkové apnoe z pohledu ortodontisty
| Title in English | Pediatric obstructive sleep apnea - the orthodontic perspective |
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| Authors | |
| Year of publication | 2021 |
| MU Faculty or unit | |
| Citation | |
| Description | Introduction: In 1976, pediatric obstructive sleep apnea (POSA) was introduced as a specific diagnosis, also because it presents with different symptoms than OSA in adult patients. Among the most frequently mentioned risk factors for the development of OSA in children are obesity, enlarged palatine and nasal tonsils, neuromuscular diseases, and last but not least, craniofacial malformations play a significant role in its development. The bony parts of the craniofacial system form the support of the upper respiratory tract and their importance for the physiological breathing of an individual is manifested especially during sleep, when there are changes in the control of muscle tone and reflex responses. Craniofacial anomalies may contribute to airway narrowing, easier collapse, and occlusion. As orthodontists are specialists in the orofacial region and anomalies in this area, especially in growing pediatric patients they can make a fundamental contribution to both early diagnosis and non-invasive treatment of patients with pediatric OSA. Methodology: As part of the initial orthodontic examination, a cephalometric image - an image of the patient's skull from the side view, is taken as standard. Based on its analysis, the orthodontist determines the relationship of the jaws and describes the skeletal basis of the given orthodontic anomaly. At the same time, this image displays the upper respiratory tract two-dimensionally and thus enables their basic control, even in relation to the jaws. Results: Cephalometric studies with pediatric patients suffering from OSA point to characteristic features that may affect airway patency and thus contribute to the development of OSA. Narrowing of the nasomaxillary complex, a visibly narrow and arched hard palate, often leading to a one- or two-sided crossbite is common. Patients have a retrognathic type of the facial skelet, midface hypoplasia, micrognathia or microgenia, i.e. underdevelopment of the jaws. An increase in the divergence of the jaw bases, the so-called skeletal open bite, which is also manifested by insufficient lip seal, is also risky. Correctly timed orthodontic treatment in children with dysmorphism, leading to narrowed upper respiratory tract, can stimulate growth or change the position of the jaws, thus improving their proper development, and at the same time reducing the risk of their collapse. An example is the relatively often used maxillary expansion or rapid maxillary expansion (RME) in orthodontic therapy. During RME, the maxilla and the dental arch expands, but at the same time the nasal floor also expands and the volume of the nasopharynx and the intranasal capacity increases, resulting in a decrease in nasal resistance. In patients suffering from maxillary constriction and symptoms of OSA, RME has been proven to improve nasal ventilation and is offered as a suitable therapy. Conclusion: Orthodontic treatment appears to be a successful therapeutic approach for OSA in pediatric patients with anomalies of the orofacial skeleton, while the key aspect in the therapy of this disease still remains a detailed anamnesis, early diagnosis and determination of causative factors followed by an interdisciplinary approach to therapy. |
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